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NRS133: Unit 6 - Shock > Shock > Flashcards

Shock Flashcards

1
Q

Shock

A

widespread abnormal cellular metabolism that occurs when oxygenation and tissue perfusion needs are not met to the level necessary to maintain cell function.

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2
Q

The 2 main problems of shock are

A

Lack of Oxygen and Tissue Perfusion

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3
Q

Causes of Hypoxia

A
  • decreased hemoglobin
  • decreased concentration of oxygen in air
  • inability of tissues to extract oxygen from the blood
  • decreased diffusion of oxygen from alveoli
  • impaired ventilation
  • poor tissue perfusion.
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4
Q

Shock is a…..

A

Condition not a disease.

If left untreated can lead to fatal cardiac dysrhythmias

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5
Q

Cardiac dysrhythmias start as and advance to…

A

Ventricular tachycardia > V Fib >Asystole (flat line)

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6
Q

Tissue Perfusion

A

delivery of blood to the capillary bed in tissues

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7
Q

SVR

A

Systemic vascular resistance

-Vasodialation or vasoconstriction

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8
Q

Info about blood flow to organs

A

Blood flow to organs varies according to need. The body can selectively increase bloodflow to some organs and decrease others. This is called shunting of blood

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9
Q

Shunting of blood

A

Blood is shut off from peripheral limbs to facilitate better blood flow to vital organs

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10
Q

MAP

A

Mean Arterial Pressure
The arterial blood pressure (between 60 and 70 mmHg) necessary to maintain perfusion of major body organs, such as the kidneys and brain.

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11
Q

CO

A

Cardiac Output
The volume of blood ejected by the heart each minute (from Left Ventricle to tissues) ; normal range in adults is 4-7 L/Min

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12
Q

SVR

A

Systemic Vascular Resistance
The resistance to the flow of blood through the body’s blood vessels; it increases when vessels constrict and decreases when vessels dilate.

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13
Q

EF

A

Ejection Fraction

The percentage of blood ejected from the heart during systole

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14
Q

Preload

A

The degree of myocardial fiber stretch at the end of diastole and just before contraction; determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart)

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15
Q

Afterload

A

The pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels; the amount of resistance is directly related to arterial blood pressure and blood vessel diameter.

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16
Q

Starling’s Law of the Heart

A

The more the heart is filled during diastole (within limits), the more forcefully it contracts.

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17
Q

Calculating MAP

A

MAP= DBP + 1/3(SBP-DBP)

Normal MAP is 93mmHg

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18
Q

What is the minimum MAP needed to perfuse vital organs

A

60 - 70 mmHg

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19
Q

What starts shock

A

Problems with oxygen delivery.

hypoxia> cell/tissue death> MODS> Death

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20
Q

Which patients are at highest risk for Shock?

A

Those in the acute care setting

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21
Q

MODS

A

Multiple Organ Dysfunction Syndrome
The sequence of inadequate blood flow to body tissues, which deprives cells of oxygen and leads to anaerobic metabolism with acidosis, hyperkalemia, and tissue ischemia; this is followed by dramatic changes in vital organs and leads to the release of toxic metabolites and destructive enzymes.

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22
Q

Titration Math

A

Total Dose Hourly Dose
________ = ___________
Total Volume Hourly Volume

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23
Q

Hypovolemic Shock Overall Cause

A

Total body fluid decrease ( in all fluid compartments)

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24
Q

Specific Cause or Risk Factors of Hypovolemic Shock

A

Hemorrhage
-Trauma, GI ulcer, Surgery, Inadequate Clotting
Dehydration
-Vomiting, Diarrhea, Heavy diaphoresis, Diuretic therapy, NG suction, Diabetes, Hyperglycemia

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25
Overall Cause of Cardiogenic Shock
Direct pump failure (fluid volume not affected) | Usually caused by a blockage of coronary artery which leads to tissue necrosis
26
Specific Cause or Risk Factors of Cardiogenic Shock
``` Myocardial infarction Cardiac arrest Ventricular dysrhythmias Cardiac amyloidosis Cardiomyopathies Myocardial Degeneration ```
27
Overall Cause of Distributive Shock
Fluid shifted from central vascular space (total body fluid volume normal or increased)
28
Specific Cause or Risk Factors of Distributive Shock
``` Neural Induced - Pain - Anesthesia - Stress - Spinal cord injury - Head Trauma Chemical Induced - Anaphylaxis - Sepsis - Capillary leak (burns, extensive trauma, liver impairment, hypoproteinemia) ```
29
Overall Cause of Obstructive Shock
Cardiac function decreased by noncardiac factor (indirect pump failure). Total body fluid is not affected although central volume is decreased.
30
Specific Cause or Risk Factors of Obstructive Shock
``` Cardiac tamponade Arterial stenosis Pulmonary embolus Pulmonary hypertension Constrictive pericarditis Thoracic tumors Tension pneumothorax ```
31
Cardiovascular Manifestations of Shock
- Decreased cardiac output - Increased Pulse - Thready Pulse - Decreased B/P - Narrowed pulse pressure - Postural hypotension - low central venous pressure - flat neck and hand veins in dependent positions - slow capillary refill in nail beds - diminished peripheral pulses
32
Respiratory Manifestations of Shock
- Increased respiratory rate - Shallow depth of respiration - Increased Paco2 - Decreased Pao2 - cyanosis, especially around lips and nail beds
33
Early Neuromuscular manifestations of Shock
- Anxiety - Restlessness - Increased thirst
34
Late Neuromuscular manifestations of Shock
- Decreased CNS activity (lethargy to coma) - Generalized muscle weakness - Diminished or absent deep tendon reflexes - Sluggish pupillary response to light
35
Kidney Manifestations of Shock
- Decreased urine output - Increased specific gravity - Sugar and acetone present in urine
36
Integumentary Manifestations of Shock
- Cool to cold - Pale to mottled to cyanotic - Moist, clammy - Mouth dry; pastelike coating present
37
Gastrointestinal manifestations of Shock
- Decreased motility - Diminished or absent bowel sounds - Nausea and vomiting - Constipation
38
Classifications of Shock
- Hypovolemic - Cardiogenic - Obstructive - Distributitve
39
Septic Shock falls under which category
Distributive Shock
40
Spinal Shock falls under which category
Distributive Shock
41
Common problems leading to hypovolemic shock are...
hemorrhage and dehydration
42
Hemodilution
causes the APPEARANCE of a decrease of HGB and HCT levels.
43
Serum Lactic Acid
3 - 7 mg/dL | Show if heading into acidosis from anaerobic metabolism.
44
Stages of Shock
1. Initial stage 2. Nonprogressive stage 3. Progressive stage 4. Refractory stage
45
Adaptive responses of Initial Stage
- Decrease in baseline mean arterial pressure (MAP) of 5 - 10 mmHg - Increase sympathetic stimulation - Mild vasoconstriction - Increased heart rate
46
Adaptive responses of Nonprogressive Stage
- Decrease in MAP of 10-15 mmHg from the patient's baseline - Continued sympathetic stimulation - Moderate vasoconstriction - Increased HR - Decreased pulse pressure - Chemical compensation (Renin, aldosterone, and antidiuretic hormone) - Increased vasoconstriction - Decreased urine output - Stimulation of thirst reflex - Some anerobic metabolism in nonvital organs - Mild acidosis - Mild hyperkalemia
47
Adaptive responses of Progressive Stage
- Decrease in MAP of >20 mmHg from the patient's baseline - Anoxia of nonvital organs - Hypoxia of vital organs - Overall metabolism is anaerobic - Moderate acidosis - Moderate hyperkalemia - Tissue ischemia
48
Adaptive responses of Refractory Stage
- Severe tissue hypoxia with ischemia and necrosis - Release of myocardial depressant factor from the pancreas - Buildup of toxic metabolites - Multiple organ dysfunction syndrome (MODS) - Death
49
O2 Saturation with Stages of Shock
Nonprogressive - 90-95% Progressive - 75-80% Refractory - Below 70%
50
Hematocrit Range
Females: 37 - 47% Males: 42 - 52%
51
Hemoglobin Range
Females: 12-16 g/dL Males: 14 - 18 g/dL
52
What fluid should you give for acidosis
LR
53
Best Practice Treatment of Hypovolemic Shock
- Ensure patent airway - start and IV catheter - administer oxygen - elevate the pts feet, keeping head flat or no more than 30 degrees - examine for overt bleeding (if present apply direct pressure) - administer drugs as prescribed - Increase the rate of IV fluid delivery - Do Not leave the patient
54
Dopamine
Vasoconstrictor Sympathomemetic Improve blood flow by increasing peripheral resistance, increasing venous return to the heart, and improving myocardial contractility
55
Sodium nitroprusside
Agent to enhance myocardial perfusion Nitrates Improves blood flow to the myocardium by dilating the coronary arteries This effect is primary and rapid but short.
56
Sodium nitroprusside | Nursing considerations and rationales
- Protect contained from light. (Light degrades drug quickly) - Assess BP q15mins (the vasodilating effect can cause systemic vasodilation and hypotension especially in older adults.
57
Dopamine | Nursing considerations and rationales
- Assess the patient for chest pain (Drug increases myocardial oxygen consumption) - Monitor urine output hourly (Higher doses decrease renal perfusion and urine output - Assess B/P q15mins (Hypertension is a sign of overdose) - Assess for headache. ( Headache is an early symptom of drug excess - Assess q30mins for extravasation and check extremities for color and perfusion. ( If the drug gets into the tissues, it can cause severe vasoconstriction, tissue ischemia, and tissue necrosis. - Assess for chest pain ( Drug can cause rapid onset of vasoconstriction in the myocardium and impair cardiac oxygenation
58
Milrione & Dobutamine
Inotropic Agents Directly stimulate adrenergic receptor sites on the heart muscle (beta, receptors) and improve heart muscle cell contraction
59
Milrione & Dobutamine | Nursing considerations and rationales
- Assess for chest pain (Drug increases myocardial oxygen consumption and can cause angina or infarction) - Assess B/P q15 mins (Hypertension is a sign of overdose
60
Collateral circulation in the heart...
increases over age because of compensation from athrosclerosis.
61
Ventricular Tachycardia...
seen in heart ischemia, leads to V-fib (3-5 mins), but is a shockable rhythm.
62
Septic Shock
- decreased BP - increased respirations and heartrate - low urine output
63
Progression of infection in Septic Shock
Local infection> Systemic Infection> SIRS (Systemic inflammatory response syndrome) > Organ failure (severe sepsis) > multiple organ system failure (MODS) (septic shock) > Death.
64
Important consideration of Blood Cultures
Collect them before hanging IV!
65
SIRS criteria
-Temp of more than 100.4 or less than 96.8 - HR >90 BPM - RR >20BPM or PaCO2 12 or <4 - Sepsis is considered present if two or more SIRS criteria are present along with any known infection and one or more of these clinical manifeststions: Hypotension, Decreased urine output, Positive fluid balance, Decreased capillary refill, Hyperglycemia, Unexplained changed in mental status, Rising creas level.
66
Conditions predisposing to sepsis and septic shock
- malnutrition - immunosuppression - large, open wounds - mucous membrane fissures in prolonged contract with bloody or drainage soaked packing - GI ischemia - Exposure to invasive procedures - Malignancy - Older than 80 - Infection with resistant organisms - Receiving chemo - alcoholism - diabetes mellitus - chronic kidney disease - transplantation recipient - hepatitis - HIV/AIDS
67
Septic Shock
the stage of sepsis and SIRS when multiple organ failure is evident and uncontrolled bleeding occurs. Greater than 50% death rate.
68
Risk factors of Hypovolemic shock
- Diuretic therapy - Diminished thirst reflex - immobility - use of aspirin-containing products - use of complimentary therapies such as Ginko Biloba - Anticoagulant therapy
69
Risk factors for Cardiogenic shock
- Diabetes mellitus | - Presence of cardiomyopathies
70
Risk factors of Distributive Shock
- Diminished immune response - Reduced skin integrity - Presence of cancer - Peripheral neuropathy - Strokes - Institutionalization - Malnutrition - Anemia
71
Risk of Obstructive Shock
- Pulmonary hypertension | - Presence of cancer
72
Pulmonary Capillary Wedge Pressure
2-15 mmHg

NRS133: Unit 6 - Shock (1 decks)

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